Failed Medicare Survey

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Specializes in ICU/CCU, Home Health, Case Management.

I work for a start up home health agency in Tampa. I applied for an RN per diem position but he asked me to be his DON because the last one resigned after 1 month. During my interview I told the Administrator I had no HH DON experience. I am a field nurse and made it very clear to him. He told me not to worry, you have excellent clinical skills and will do fine. I told him I had no coding experience either.He told me not to worry about survey, they don't read nn, they just go on field visits, and hand washing, teaching pt.,bag technique, the skills I know blind. I asked him weekly prior to survey to review all the administration checklist, standards and COPs. I had to put all the manuals together, adm. packet, etc.Because we had to care for pts. for free, he told me to put no payment necessary on OASIS and tell pts their care was free, their ins. would not be billed, 10 MCD and 2 MCR pts. the company was cited for this. He blamed me. He applied for deemed status. He was cited for not having a PAC committee, the surveyor told him this was a severeinfraction. I am the only RN and have been doing the vis and not having an RN pass me off on skills. He said we didn't need this.He is firing me -gave me 2 weeks. He just hired a friend as PerDiem LPN.And, I had to self teach on line Agency core, axxess program! I tried to defend myself and he said let's not blame anyone for failing, let's fix the citations!! Help, please. He told me not to tell the owner or document he told me not to tell pts their care was free! So sorry this is long, but I needed to let you all know what just happened to me!I am the only RN to do everything Administative and clinical, visits, etc!

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Sounds to me like your administrator needs to brush up on his regulations, and he clearly doesn't know what he is doing if he told you the surveyor doesn't read nurses notes. With the small amount of patients at start up, it's not uncommon for an RN to be the DON, sometimes even the administrator, as well as doing the patient care, in the interest of saving money until you pass survey and can bill for services. He should have listened to your concerns when you told him you had concerns about never being a DON, particularly since this was a start up agency. Do not feel bad, it's not your fault he was incompetent, and it is HIS fault the agency didn't pass survey. The owner will eventually find out as they will have to spend more money to keep the agency going until the follow up. I don't understand what you mean by having another RN pass you off on the skills(?). The patients don't have to know survey wasn't passed, their care should not be impacted. I am sorry that your first DON experience was a bad one, but you trusted he knew what he was doing when he clearly didn't. You as well should have known per regulations what your role was , as the surveyor does not accept "I didn't know"as a reason not to have followed regulations.

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Yikes! What a scary place to rely on as a patient.

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Specializes in ICU/CCU, Home Health, Case Management.

Update! We passed-Administrator had to put together a Prof. Advisory Comm. Mtg Manual, to pass!! My few things in documentation I corrected, but he said "he never told us we failed!!!!" I was not hearing things! Learning not to trust people who say "don't worry about it" one minute and then say the owner wants to fire you, the next! Getting experience with coding, qa, etc and then will move on.

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I don't think it's fair that he gets to stay and you have to go. I would let the owner know what really happened before being made to be the scapegoat

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Specializes in ICU/CCU, Home Health, Case Management.

TY LaRN! They are friends! And, the owner knows less than the administrator re:homecare. So, I will stay and self teach as much as I can. He hired a marketing liaison, so MCR pts. will be coming in soon. As soon as I see that my license is in jeopardy I am out of there. He has no Administrator license to lose. Good thing I renew my malpractice q yr on my birthday-I have never needed to use it, and I hope I ever have to. I am using Axxess software and it's a tough program to learn. I liked Kinnser better. Happy Fall!

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wow, a home health owner that doesn't know jack about the business. they better be very fast learners or hire a team of consultants, because the days of learning-as-you-go are pretty much over. They can barely figure out how to get licensed, curious to see how they will handle billing. too many errors and medicare will turn all their plus signs into minus signs.

Axxess does an absolute AWEsome JoB at promoting and advertising their product. Unfortunately that's the only thing they do well.

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Specializes in ICU/CCU, Home Health, Case Management.

How true La.....He will be in the hotseat (or he throws me under the bus, again!) soon! When I interviewed I told him at 2 interviews I knew basic coding BUT nothing about case mix, etc. There is so much to learn AND I told him and have reminded him weekly I have never done billing-I don't even balance my checkbook. He said Oh Axxess will do the billing!!!Who is going to handle all the audits, bills not accepted....... I could go on and on.. I am keeping my eyes and ears open. Something will come.

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I wouldn't depend on Axxess to handle my grocery list even.

did the owner really hire a friend with no HH experience to run his company?

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Specializes in ICU/CCU, Home Health, Case Management.

Supposedly he was an Administrator for a brief time at a small company that did managed care,not MCR. Not sure, I didn't look at his personnel file.

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Specializes in ICU/CCU, Home Health, Case Management.

I suggested to hire consultants and was told NO we don't need them!!! Imagine making a policy and procedure manual from google! Not to mention all the other logs I had to put together! He said, " what goes on in this office stays here the owner doesn't need to know", but don't ya know he through me under the bus in front of the owner during survey! Live and learn. I agree about Axxess, he told me we will learn the billing together. I said nothing!! He shows up q 2wks for 15 minutes in shorts and a t shirt!I will be leaving soon--I value my 2 licenses too much and as we all did-worked hard for them!

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Specializes in ICU/CCU, Home Health, Case Management.

Yes, a friend he plays pool and fantasy football with, as does the secretary I work with 20 hrs! She complains about being bored! I also found out, the owner lost his bid for the DME company he owned for 12 years. The saga goes on Admin. -he has 2 other jobs, too, during his working hrs! One is working with a wound care salesman and the other is helping owner with an audit! I can never reach him, never responds to my emails, text messages, phone calls. Obviously, he does not want a paper trail! I document communication notes and emails to him and print them for me to cover my myself. Marketer is going to earn 80k plus bonus! She drives a Lexus and he drives a Jag! I drive a beata up used Camry!!! It works for me!

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